Sheila Fomenky
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Springfield, MO
NPI 1144709247 · NPPES record last updated Aug 27, 2021
Key facts
- NPI
- 1144709247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2021032055 (MO)
- Practice address
- 3600 S National Ave
Springfield, MO 65807-7311 - Phone
- (417) 322-6622
- Fax
- (417) 350-1935
- NPI assigned
- Aug 9, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Thrive Counseling LLC
Practice addresses (Care Compare)
1000 Post and Paddock St
Suite 102
Grand Prairie, TX 75050-1114
Phone (855) 284-7483
1412 W Magnolia Ave
Suite 210
Fort Worth, TX 76104-4364
Phone (855) 284-7483
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230203001451 | TX | Practitioner - Nurse Practitioner | 6406251479 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 869928 | TX | MD | Registered Nurse |
| 2021032055 | MO | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Calmyou Psychiatry | Current | Accepting new patients | |
| Thrive Counseling LLC | Current |
Accepting new patients | |
| Eustasis Foundation, Inc | Past |
Accepting new patients |
Locations
1942 Broadway
Ste 314C
Boulder, CO 80302
Phone (719) 203-1465
1000 Post and Paddock St
Ste 102
Grand Prairie, TX 75050
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 869928 | TX | |
| Nurse Practitioner | 363L00000X | 2021032055 | MO | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2021032055 | MO | Yes |
Addresses
Primary practice location
3600 S National Ave
Springfield, MO 65807-7311
Mailing address
3600 S National Ave
Springfield, MO 65807-7311
Phone (417) 322-6622
Other providers in Springfield, MO
- Joseph Killian Flynn
- Katherine Foerster
- Sara Anna Foley
- Howard W Follis
- Angela J Folstad
- Robyn D Fondren
- Trista E Fongemie
- Sarah Fontana
- Food Merchants LLC
- Food Merchants LLC
All providers in Springfield, MO · Psychiatric/Mental Health Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.